CPT 99459

Pelvic Examination

CPT 99459 pays $17.37 in a non-facility setting and $17.37 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $14.92 in Arkansas to $20.55 in California, a 38% spread.

National non-facility rate

$17.37

Office and other outpatient settings

Facility rate
$17.37

Hospital and ASC settings

Highest state
$20.55

California

Lowest state
$14.92

Arkansas · 38% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $17.37
CPT 99459 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $17.37, national facility $17.37.
StateRate compared visuallyNon-facilityFacility
California
$20.55$20.55
District of Columbia
$20.46$20.46
Washington
$19.80$19.80
Hawaii
$19.75$19.75
New Jersey
$19.56$19.56
Massachusetts
$19.51$19.51
New York
$19.38$19.38
Connecticut
$18.71$18.71
Alaska
$18.50$18.50
Colorado
$18.48$18.48
Oregon
$18.30$18.30
Maryland
$18.11$18.11
New Hampshire
$18.08$18.08
Rhode Island
$17.94$17.94
Minnesota
$17.87$17.87
Puerto Rico
$17.56$17.56
Virgin Islands
$17.56$17.56
Florida
$17.43$17.43
Nevada
$17.39$17.39
Montana
$17.37$17.37
North Dakota
$17.37$17.37
South Dakota
$17.37$17.37
Wyoming
$17.37$17.37
Vermont
$17.19$17.19
Delaware
$17.16$17.16
Texas
$17.10$17.10
Virginia
$17.07$17.07
Pennsylvania
$17.01$17.01
Arizona
$16.83$16.83
Illinois
$16.78$16.78
Wisconsin
$16.64$16.64
Maine
$16.60$16.60
Georgia
$16.57$16.57
Utah
$16.33$16.33
Michigan
$16.31$16.31
North Carolina
$16.20$16.20
Indiana
$16.10$16.10
South Carolina
$16.05$16.05
Nebraska
$16.03$16.03
Idaho
$15.98$15.98
Missouri
$15.94$15.94
New Mexico
$15.93$15.93
Iowa
$15.89$15.89
Louisiana
$15.86$15.86
Ohio
$15.86$15.86
Tennessee
$15.79$15.79
Kansas
$15.70$15.70
Oklahoma
$15.51$15.51
Kentucky
$15.44$15.44
Alabama
$15.20$15.20
West Virginia
$15.09$15.09
Mississippi
$14.95$14.95
Arkansas
$14.92$14.92

Billed by 1 specialties

Commercial rates for 99459

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates